Calls for CPR guidelines to be changed

Mar 31 2008

The results of new research has thrown into question cardiopulmonary resuscitation (CPR) techniques which have for decades been deemed best practice in Australia.

Studies by researchers in the United States have revealed that patients are more likely to survive if CPR is done without mouth-to-mouth and were also less likely to have brain damage.

The Arizona scientists say minimally interrupted cardiac resuscitation (MICR) offers 'out of hospital' heart attack victims a better chance of survival.

The research has prompted the Australasian College of Emergency Medicine to suggest that the 'kiss of life' should be abolished and be replaced with chest compressions only as this would save more lives.

The U.S. researchers from emergency medical centers in Scottsdale, Phoenix and Tucson in Arizona say out-of-hospital cardiac arrest is a major public health problem.

The researchers say mouth-to-mouth ventilation is often a barrier to bystanders doing CPR so they carried out an observational study of patients who had out-of-hospital cardiac arrest.

The researchers questioned paramedics called to the scene about the CPR delivered by bystanders who witnessed the cardiac arrest.

They discovered that of over 4,000 adult patients who had out-of-hospital cardiac arrest, of those who received help there was no evidence of any benefit from the addition of mouth-to-mouth ventilation.

The researchers say cardiac-only resuscitation by bystanders is the preferable approach to resuscitation.

The Australasian College of Emergency Medicine says national cardiopulmonary resuscitation (CPR) guidelines need to be revised and chest compressions only recommended.

The college says the evidence suggests that patients were more likely to survive without brain damage if CPR was done without mouth-to-mouth and this is enough for the guidelines to be changed.

Any change to CPR guidelines would have implications for many such as workplace first aid officers, child carers, teachers, health workers, surf lifesavers, lifeguards, doctors, nurses and emergency workers.

The Australian Resuscitation Council (ARC) which oversees CPR guidelines, appears reluctant to make the changes but says the research does raise concern.

ARC however does appear to moving in that direction as guidelines revised in 2006 recommend that - any attempt at resuscitation is better than none, interruptions to compressions should be minimised, compressions should be delivered faster and harder, over ventilation should be avoided and a defibrillator should be attached and used as soon as possible.

The researchers say patients who receive minimally interrupted cardiac resuscitation (MICR), are three times more likely to survive a heart attack and MICR is a better emergency protocol.

They say their results need to be confirmed in a randomized trial.

Research published last year found patients were more likely to recover without brain damage if first-aiders focused on compressions rather than breaths.

The research is published in JAMA and the Lancet.